NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.

March 23, 1995

The Honorable Jesse Helms
United States Senate
Washington, D.C. 20510

Dear Senator Helms:

Thank you for your letter of February 9, on behalf of your constituent, Dr.
James A. McQueen, MD. Dr. McQueen wrote to you in regards to Occupational
Safety and Health Administration (OSHA) Tuberculosis (TB) regulations he
believed were effective January 1.

In Dr. McQueen's letter he provided copies of several documents related to
tuberculosis. These documents were not prepared nor issued by OSHA. OSHA
has not promulgated regulations pertaining to tuberculosis. The material
supplied by Dr. McQueen apparently was written by two physicians from Duke
University and covers TB control in healthcare settings. The questionnaire
and the drug treatment regime mentioned in Dr. Purcell's letter and provided
in his enclosure are not OSHA requirements. OSHA's current inspection
procedures are based on a compliance memorandum issued October 8, 1993
(enclosure). The enforcement guidelines from that memorandum follow the 1990
Centers for Disease Control and Prevention (CDC) Guidelines for TB. The
provisions of the compliance memorandum would not become effective until
there was an actual exposure case at a facility.

On October 28, 1994, the CDC issued their revised guidelines for
Tuberculosis. Under these guidelines the recommendations apply primarily to
inpatient health care facilities including hospitals, medical wards in
correctional facilities, nursing homes, and hospices. The guidelines also
include recommendations that apply to ambulatory care facilities, emergency
departments, home health care settings, emergency medical services, medical
offices, and dental settings. These guidelines are currently being reviewed
by OSHA for the development of a compliance directive to replace the October
8 compliance memorandum.

Although the compliance memorandum is an enforcement policy, and not a
regulation, OSHA has been petitioned by five different unions to develop a
standard. OSHA is proceeding with rulemaking. When a proposed regulation is
published in the Federal Register comments from the public will be solicited.
Docket #H-371 has been opened for this purpose.

We hope that this letter addresses your concerns, if you have any further
questions please do not hesitate to contact Richard Fairfax in the Office of
Health Compliance Assistance at (202) 219-8036.

In my medical opinion the new OSHA T.B. regulations, effective January 1,
1995, (copy enclosed) represent unnecessary governmental intrusion into the
practice of medicine, especially in the area of Pediatrics. Not only will
the implementation of these regulations greatly increase the cost of medical
care to our patient population, it will also offer little, if any, benefit in
the area of general public health.

If I may offer only one example. The initial questionnaire is flawed and
ill-suited for evaluating the Pediatric patient. A chronic cough in a child
is a rather common complaint in a Pediatric practice, while T. B. in a child
is a very rare occurrence, even in rural, indigent North Carolina. Moreover,
a chronic cough is not usually a presenting symptom of childhood tuberculosis
disease. Much more common causes of such a common cough include the
following:

1) Upper respiratory illnesses, which may be caused by many
viruses and may follow one another in rapid succession, especially in
children in a school or day-care environment.

6) Exercise induced bronchospasm. 7) Habitual cough. 8) Even
the aspiration of a foreign body, such as a peanut, into the pulmonary tract
is probably more common than childhood tuberculosis disease.

Some children who present with a chronic cough will need medical tests, such
as a chest x-ray, to establish the etiology of the cough. However, to subject
all such patients arbitrarily to often unnecessary expensive tests, such as
chest x-rays, seems, to me, unconscionable. The patient should be evaluated
according to good individual medical judgment, based on medical history
including family history, a thorough physical exam, and medically indicated
lab and x-ray evaluations, not by governmental edict.

It should also be noted that even if a child does indeed have primary
pulmonary tuberculosis, as opposed to an adult with cavitary pulmonary
tuberculosis, he, the child, is not contagious and poses no public health
risk to those around him. Therefore, the mandated mask and isolation
precautions called for in the OSHA regulations seem ludicrous.

These are not the only problems with the OSHA T.B. regulations. But they
are enough, I hope, to lead to a reassessment of these new expensive,
expansive governmental regulations and their impact on the practice of
Pediatrics in United States of America.

Thanking you in advance for your attention in this matter, I remain.

Sincerely,

James A. Mcqueen, M.D.

Enclosure

(For Enclosure, see printed copy)

NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.

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